All that you should know about Achilles Tendinitis

Health
Tuesday, 03 November 2015 574 Views 0 Comments
All that you should know about Achilles Tendinitis

By Shailja Kaushik

Achilles tendinitis is one of the most common injuries in sport accounting for 6-17% of all running injuries. [i], [ii] Individuals participating in middle and long-distance running, badminton, soccer, volleyball, orienteering, track and field are prone to Achilles tendinitis.

What is Achilles tendinitis?

The Achilles tendon is a band of tissue that stretches from the back of the heel bone to the calf muscles above your heel. It enables foot flexion and the ability to point toes downward.

Inflammation of the Achilles tendon due to overuse, or too much impact causes Achilles tendinitis. Depending on the part of the tendon that is inflamed, it is classified into two types:

  1. Non-insertional Achilles tendinitis involves fibers in the central part of the tendon. This is more commonly found among the young athletes.
  2. Insertional Achilles tendinitis is found where there is degeneration of fibers in the tendon, at the point of its insertion into the heel bone. This may affect even those who are not very active.

Causes:

The following factors increase the risk of Achilles tendinitis:

  • An abrupt increase in the intensity or amount of physical activity
  • Tight calf muscles
  • Running or working out on hard surfaces
  • Wearing improper shoes that do not give adequate cushioning-effect
  • Overpronation of the foot
  • Bone spurs i.e. growth of the extra bone where the Achilles tendon inserts into the bone of the heel
  • Older athletes face higher risk than younger ones.

Symptoms

  • Achilles tendinitis is characterised by pain around the Achilles tendon which is worse in the morning.  It is felt while touching the area or simply when wearing shoes. Localised swelling may or may not be present
  • Patients with Achilles tendinitis usually complain of intermittent symptoms. For example, the pain may be more severe when the person is resting but may completely subside during exercise
  • Burning pain is felt along the entire length of the tendon or on the heel
  • Stiffness along the Achilles tendon in the morning or when climbing stairs is also common.  This may lead to abnormal gait
  • Most often patients are able to do daily chores, but the condition limits their ability to carry out sports activities
  • Crackling sound (medically known as crepitus), inflammation and a palpable nodule are typical signs of severe or chronic cases.
  • In chronic cases of Achilles tendinitis, a nodule of mucoid degeneration forms in the body of the tendon.[iii] The difference between acute and chronic tendinitis is shown by the rapidity of onset of symptoms and their response to pre-activity warming-up. In its acute state, symptoms have a rapid onset but can be helped markedly, if not totally, by warming-up exercises. Chronic tendinitis is of more insidious onset and symptoms are not helped by warm-up.[iv]

Prevention

Being flexible is the key to prevention. Runners and athletes should spend some time doing appropriate stretches and strengthening exercises involving the calf and ankle joint, before exercising. The easiest and most effective stretching exercise is to stand against a wall and try to push it with both hands while keeping one foot behind the other on the ground. This will make the Achilles tendon strong and flexible. Light massage to the calf muscles and tendons helps to reduce tightness and increase flexibility.

Treatment

The goal of treatment is to return the patient to the desired level of physical activity without residual pain. In athletes, an additional demand is that the recovery time should be as short as possible.[v] In the book Primary Care: A Collaborative Practice (by Terry Mahan Buttaro), management of Achilles tendinitis is summarised as follows:

Treatment of the acute phase begins with the cessation of all sports activities and exercises. Tendon rest is imperative to avoid further injury. In severe tendinitis, crutches and partial weight-bearing are indicated. NSAIDs and an ice massage for 20 minutes, three to four times a day, helps decrease inflammation and pain. A simple shoe insert that raises the heel approximately 2 cm also helps ease strain on the tendon.

In more severe cases, ultrasound therapy as an adjunct therapy is used. Regular follow-up visits to assess progress and to discourage the patient from returning to activity prematurely are necessary. Resolution of acute tendinitis can take 8 weeks or longer. A program of stretching and strengthening begins when pain and swelling have subsided. Many patients can recover with exercise alone.

Some tips for faster recovery are:

  • Rest
  • Stop any activity that causes pain
  • Do alternative low-impact exercises such as swimming, biking etc.
  • Walk or run on soft surfaces
  • Wear proper shoes
  • Use a brace, cast or heel lifts.

Only when the pain does not get better after 6 months of conservative treatment, can surgery be considered.  Three kinds of surgical interventions are possible:

  • Increasing the length of the calf, known as gastrocnemius recession, to give flexibility to the tendon.
  • Removing the damaged part of the tendon and repairing the rest with stitches and sutures. This is done when damage is less than 50%.
  • When the damage to tendon is greater than 50%, transfer of Achilles tendon is performed.

Recovery from surgery depends on the extent of tendon damage. Greater the damage, longer will be the recovery time. Sometimes when the damage is severe, the athletes may not be able to make a satisfactory comeback to sports. Physical therapy and a good rehabilitation strategy are very important for the complete recovery of patients. Achilles tendinitis is a slow healing, frustrating and recurrent problem. Patients with this condition need support during rehabilitation and should be educated about proper care.

References

Sandy Fritz. Sports and Exercise Massage: Comprehensive care in athletics, fitness and rehabilitation. Elsevier Health Sciences. 2012.

Ankle. Achilles Tendinitis: Prevention and Treatment. Peak Performance. 2002.
[i]Alfredson H, Lorentzon R. Chronic Achilles tendinosis. Recommendations for treatment and prevention. Sports Medicine 2000; 29(2):135–146.
[ii]Myerson 1999 Myerson MS, McGarvey W. Disorders of the Achilles tendon and Achilles tendinitis. AAOS Instructional Course Lectures 1999; 48: 211–218.
[iii] Terry Mahan Buttrao. Primary Care: A Collaborative Practice. Elsevier Health Sciences, 2013.
[iv]Renstrom 1994 Renstrom AFH. An introduction to chronic overuse injuries. In: Harris M, Williams C, Stanish WD, Micheli LJ editor(s). Oxford Textbook of Sports Medicine. New York: Oxford University Press, 1994:531–45.
[v] Mika Paavola; Pekka Kannus; Tero Jarvinen; Karim Khan; Laszlo Jozsa and Markku Jarvinen. Current Concepts Review – Achilles Tendinopathy. The Journal of Bone and Joint Surgery. 2002.

(Dr. Rohan Habbu is an Orthopedic Hand, Nerve & upper Extremity Surgeon. He has done Fellowship in Arthroscopy & Sports Surgery and is an avid runner. To know more, reach out to him on rohanhabbu@gmail.com or +91 982017 13941)

Print Friendly, PDF & Email